An irrevocable trust earns its price in a few specific situations. Each one is attorney work: the drafting details decide whether the benefit exists at all, so use a licensed estate planning or elder law attorney. Here's when the tool fits.
Medicaid and long-term care. An irrevocable trust drafted so that no payment can ever come back to you removes those assets from Medicaid's eligibility count: federal law treats them as given away once the trust can't pay you.[9] The catch is timing. That transfer sits inside Medicaid's look-back, which runs 60 months, and a transfer inside the window triggers a penalty period of ineligibility.[9] So this works only as planning done five years ahead, while you're still healthy.
State rules move constantly underneath this. California eliminated asset limits for its non-MAGI Medi-Cal programs, the ones long-term care runs through, on January 1, 2024, then reinstated them on January 1, 2026, at $130,000 for an individual.[10] And qualifying is half the problem.
After a recipient dies, states must seek repayment of long-term care costs from the estates of recipients who were 55 or older,[11] and federal law lets each state define "estate" to include assets that passed outside probate, naming living trusts specifically.[9] In a state using that expanded definition, a revocable trust does nothing to stop recovery.
Planning around all of this is exactly what elder law attorneys do, state by state.
Life insurance: the ILIT. An ILIT, short for irrevocable life insurance trust, is an irrevocable trust that owns life insurance on your life, built so the death benefit stays out of your taxable estate.[12] The mechanics: insurance proceeds count in your gross estate if you held any of what the tax code calls incidents of ownership in the policy at your death.[13]
When the ILIT owns the policy and its trustee holds those rights, you hold nothing to include. One timing rule matters. Transfer an existing policy into the trust and die within three years, and the proceeds get pulled back into your estate; a policy the trust buys new avoids that rule.[14]
With the federal exclusion at $15 million,[6] an ILIT is a tool for large estates and for states that tax at much lower levels. Most households don't need one. The people who do usually know it, because the policy plus the business plus the house clears their state's threshold.